What You, Bono, and African Babies Have In Common

2010-01-28-RwandaPhotos51_jpg.jpgEver look at people like Bill Gates and Bono and wonder what you could possibly have in common? Or look at a baby born in rural Africa and think how different you are?

Well, actually you, Bill Gates, Bono, and the African baby all have something in common. As infants you were all infected with rotavirus, the leading cause of severe diarrhea around the world. That's right, this "equal opportunity" virus infects everyone, everywhere -- regardless of the level of sanitation and hygiene where you live -- by their second birthday.

But the similarities stop with the risk of infection. It's the consequences of infection that are drastically different. The risk of dying due to rotavirus diarrhea is 200 times greater in Malawi than in Ireland, according to WHO statistics. This increased risk of death is due to a lack of access to reliable, quality health care and a higher prevalence of underlying diseases like malnutrition that make children in Africa and elsewhere more likely to succumb to rotavirus diarrhea than their counterparts in the USA or Ireland.

Improving sanitation and hygiene in Africa and elsewhere is both urgently needed and likely to diminish some of the important causes of diarrhea. But it won't stop rotavirus infections. For rotavirus prevention we need vaccines that are safe and effective for use in developing countries. And in this week's edition of the New England Journal of Medicine we have new evidence that rotavirus vaccines are indeed safe and effective in these very populations.

The report this week from Shabir Madhi and colleagues provides evidence to show that whether used in Soweto, South Africa or in a more rural part of Africa - Malawi, the children who received rotavirus vaccine were significantly protected against rotavirus disease compared to the children who did not get the vaccine. Interestingly, the greatest overall health impact - that is, the number of cases of severe disease prevented - was greater in the Malawi part of the trial (6.7 cases prevented annually per 100 vaccinated children as compared to 4.2 in South Africa). This is ironic because as a percentage the vaccine's efficacy was lower in Malawi (49%) than it was in South Africa (77%).

One way to think about this is to ask yourself would you rather have 49% of Bill Gates' fortune or 77% of mine? The answer is simple and so is understanding the rotavirus efficacy trial data. The risk of rotavirus diarrhea is so much higher in Malawi than in Soweto that even a smaller percent reduction means many more cases are prevented than when you have a lower incidence of rotavirus but a higher percent reduction.

In short, the very places with the highest risk of disease are the places where children will most immediately benefit from this vaccine. And they are exactly where their parents and governments are least able to afford them.

So, now that we know rotavirus vaccines can protect children in Africa, here's another way for you to be like Bill Gates and Bono. Take up their cause and make sure that all children everywhere have access to these life-saving vaccines. To find out more, check out GAVI on Twitter or Facebook.